A new study finds that women in their 40s with dense breasts benefit from annual mammograms.

WOMEN IN THEIR 40s MAY BENEFIT FROM ANNUAL MAMMOGRAMS

The U.S. Preventive Services Task Force (USPSTF) ignited a firestorm of controversy in 2009 when the government agency recommended that most women between the ages of 50 and 74 should undergo screening mammograms every other year,instead of every year.Even more controversial was the USPSTF’s recommendation that most healthy women between the ages and 40 and 49 should no longer undergo routine screening mammograms.Numerous cancer advocacy groups, including the American Cancer Society, subsequently recommended that the USPSTF’s revised guidelines for screening mammograms should, essentially, be ignored, and that women with an average risk of developing breast cancer should continue to undergo annual screening mammograms starting at age 40.

In 2010, following the USPSTF’s controversial recommendations, a significant drop in the number of annual screening mammograms performed on women in their 40s was observed, leading to concern among some breast cancer experts that many cases of breast cancer might go undiagnosed among 40 to 49 year-old women.

Now, a newly published study, which appears in the online edition of JAMA Internal Medicine, provides important new data regarding the potential impact of switching from annual screening mammograms to every-other-year (biennial) mammograms.

In this very large study, researchers analyzed prospectively collected data from mammography facilities throughout the United States that participated in the Breast Cancer Surveillance Consortium.Data was prospectively collected on 11,474 women who had been diagnosed with breast cancer and 922,624 women without breast cancer.

The findings of this enormous public health study strongly suggest that the USPSTF’s recommendations that women between the ages of 50 and 74 undergo every-other-year mammograms may actually be reasonable and safe.When compared to women in this age range who underwent screening mammograms every year, the women who underwent biennial mammograms did not have a higher incidence of advanced-stage breast cancers.An additional important finding was that even women aged 50 or older with very dense breast tissue, or women above 50 who had taken hormone replacement therapy, appeared not to experience any harm by undergoing biennial mammograms instead of annual mammograms.As both of these factors increase a woman’s lifetime risk of developing breast cancer, the finding of this study that women between 50 and 74 years of age can safely undergo screening mammograms every other year (instead of every year) is of particular significance.

In contrast to women between the ages of 50 and 74, this research study’s findings regarding women between the ages of 40 and 49 call into question the USPSTF’s recommendation that women in this age range need not undergo regular screening mammograms.Among the women in this study between the ages of 40 and 49, every-other-year screening mammograms (rather than every year) resulted in a significant increase in the incidence of more advanced-stage breast cancers.In fact, women in this age range, who often have very dense breast tissue, were 89 percent more likely to be diagnosed with advanced-stage breast cancers if they underwent every-other-year mammograms when compared to comparably aged women with dense breast tissue who underwent annual screening mammograms.

I consider this to be a very important clinical research study, and its findings may well lead to changes in the current recommendations regarding screening mammograms.At the same time, it will be important to follow the nearly one million women who participated in this public health study, to see if breast long-term cancer survival rates are impacted by the timing of screening mammograms (i.e., annual versus biennial mammograms).

It is critically important to avoid the multiple lifestyle and dietary factors known to increase the risk of breast cancer.For more research-based information on this important topic, please read the extended chapter on breast cancer in my bestselling book, A Cancer Prevention Guide for the Human Race.

According to recent Bureau of Labor Statistics, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is more than 12 percent. A new website, Veterans in Healthcare, seeks to connect veterans with potential employers. If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.

Disclaimer: As always, my advice to readers is to seek the advice of your physicianbeforemaking any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month. Over the past 12 months, more than 3.1 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious readers. As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.

Comments Off on New Government (USPSTF) Warning on Hormone Replacement Therapy Risks

A new report by a U.S. Government task force (USPSTF) recommends against the use of hormone replacement therapy due to serious health risks.

NEW GOVERNMENT (USPSTF) WARNING ON HORMONE REPLACEMENT THERAPY RISKS

As I discuss in my bestselling book, A Cancer Prevention Guide for the Human Race, there is now solid evidence that the most commonly used form of hormone replacement therapy (HRT) is associated with a significant increase in the risk of developing breast cancer, and that risk continues to rise with the duration of HRT use.

Like many cancer experts, I have taken issue with some of the U.S. Preventive Services Task Force’s (USPSTF) recent revisions of longstanding cancer screening recommendations, including, particularly, their 2009 recommendation that annual screening mammograms be started later in life than most experts have recommended (and continue to recommend), and performed less frequently among middle-aged women than most experts have also recommended. More recently, in 2011, the USPSTF’s blanket recommendation that routine PSA screening for prostate cancer be largely abandoned has not been warmly embraced by me, nor by many other cancer prevention experts, given that we still cannot determine, in advance, which men with prostate cancer will be helped by treatment for this disease and which men will not benefit (and, hence, may actually even be harmed) by being treated because they have an indolent form of prostate cancer that poses no threat to their lives (Does PSA Testing for Prostate Cancer Save Lives?).

Now, the USPSTF is weighing in on another controversial cancer-related issue: hormone replacement therapy. Prior to 2002, more than half of all American women took some form of HRT to treat the common symptoms of menopause, including hot flashes, night sweats, vaginal dryness, and irritability. As I discuss in my forthcoming book on the tragic history of HRT, The Manufactured Myths of Menopause and Hormone Replacement Therapy: A Legacy of Suffering and Death, the intentionally deceptive multi-decade marketing of HRT drugs as a panacea for the both the real and imagined consequences of menopause, and the skillful (if duplicitous) portrayal of menopause as a pathological disease that renders its “victims” something less than feminine, was only recently revealed to be a collection of gross distortions (to put it mildly) on the part of the dominant manufacturer of HRT medications. Thanks to the landmark findings of the enormous Women’s Health Initiative study, which was published in the Journal of the American Medical Association in 2002, we now know that long-term HRT use is clearly associated with an increased risk of multiple and serious health problems, including an increased risk of breast cancer.

The USPSTF is now about to weigh-in on the issue of HRT, in a paper that is to be released in the June 4th issue of the Annals of Internal Medicine. Unlike their other recent controversial pronouncements, however, I actually find the USPSTF’s new recommendations against the routine use of HRT to be very close to my own recommendations, and so I am including their review of the existing clinical research data on HRT in this column.

After comprehensively reviewing the data from 9 different prospective, randomized, placebo-controlled, blinded clinical studies (including the massive Women’s Health Initiative study), the USPSTF study group determined that both estrogen-progesterone (combination) HRT and estrogen-only HRT significantly increased the risk of stroke, potentially fatal blood clots (venous thromboembolic disease), gallstones, and urinary incontinence. Estrogen-progesterone (combination) HRT was also, once again, shown to be associated with a significantly increased risk of breast cancer, as well as a probable increase in the risk of dementia. (On the other hand, estrogen-only HRT, which can only be taken by women who have previously undergone hysterectomy, appears to actually decrease the risk of developing breast cancer, while both types of HRT also appear to reduce the risk of osteoporosis-associated bone fractures.)

Based upon the increasingly large amount of available clinical research data, HRT, of any type, cannot currently be recommended for routine long-term use, given the multiple and significant health risks associated with both estrogen-only and estrogen-progesterone forms of HRT. After decades of intentionally misleading advertising by the manufacturer of the two most frequently prescribed forms of HRT, and the manufacturer’s intentional co-opting of numerous women’s physicians over the years, the true risks associated with the long-term use of HRT have now become abundantly clear. I will have much more to say about this cautionary tale when The Manufactured Myths of Menopause and Hormone Replacement Therapy: A Legacy of Suffering and Death is published in early 2013….

Disclaimer: As always, my advice to readers is to seek the advice of your physicianbeforemaking any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month. (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!) As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.

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OCTOBER IS NATIONAL BREAST CANCER

AWARENESS MONTH

MAMMOGRAMS BETWEEN 40 AND 49 YEARS OF AGE

Both patients and their physicians were stunned last year when the U.S. Department of Health and Human Services’ U.S. Preventive Services Task Force (USPSTF) recommended against routine annual screening mammograms in women between the age of40 and 49 years (as has been the standard recommendation in the United States, and in most countries around the world, for many years).The USPSTF’s recommendations quickly set off a firestorm of debate regarding the calculations and public health considerations used by the USPSTF to arrive at this surprising recommendation.Since the USPSTF released its recommendations in the fall of 2009, most breast cancer specialists and breast cancer advocacy groups have continued to recommend that women who are at average risk of developing breast cancer begin routine annual screening mammograms at age 40.

As I extensively discuss in my new book, A Cancer Prevention Guide for the Human Race, there is ample available clinical research data showing that screening mammograms detect breast cancer at an earlier stage than other commonly available screening methods, and that survival is improved in women in whom breast cancer is first detected by a mammogram (as opposed to the detection of a palpable or visible breast mass).

Now, a newly published large-scale public health study from Sweden, which appears in the current issue of the journal Cancer, offers further important evidence that the routine use of annual screening mammograms among women between 40 and 49 years of age significantly reduces the risk of dying from breast cancer.

In this enormous study, women between the ages of 40 and 49 years were separated into two groups, depending upon whether or not they underwent annual screening mammograms between 1986 and 2005 (the average duration of patient follow-up in this study was a very impressive 16 years).In this very powerful research study, young women who underwent annual mammograms accounted for 7.3 million “person-years” of observation, while the young women who did not undergo mammograms accounted for a similarly astonishing 8.8 million “person-years” of observation within this landmark public health study.

When the number of breast cancer deaths were assessed in both of these huge groups of young women, the women who underwent routine annual mammograms were found to be 29 percent less likely to die of breast cancer when compared to the young women who did not undergo annual mammograms!(In public health terms, this 29 percent observed reduction in the death rate due to breast cancer is highly clinically significant!)

This public health study, which encompassed the entire country of Sweden, is the largest mammography study of its kind, and its findings are both powerful and persuasive in defense of beginning routine annual screening mammograms at the age of 40 in women who are at average risk of developing breast cancer.It is my hope that the dramatic findings of this huge clinical study will now lay to rest any lingering doubts regarding the effectiveness of screening mammograms, beginning at 40 years of age, in reducing the risk of death due to breast cancer.

In recognition of Breast Cancer Awareness Month, I urge our tens of thousands of regular Weekly Health Update readers to join in the global fight against breast cancer.There are numerous organizations and groups, in virtually every community, that are sponsoring fundraising activities throughout October, including the Susan G. Komen Race for the Cure.Another opportunity to participate (and at no cost!) is to vote for the Dr. Susan Love Research FoundationArmy of Women project in the Pepsi Refresh competition!There are also many other worthwhile and deserving fundraising programs available for everyone to become involved in!

For an evidence-based discussion of the critical importance of breast cancer screening, including mammograms, in a cancer prevention lifestyle, order your copy of my new landmark book, “A Cancer Prevention Guide for the Human Race,” from Amazonor Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!

Disclaimer: As always, my advice to readers is to seek the advice of your physicianbeforemaking any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author

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I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month.(As of 9/16/2010, more than 1,000,000 health-conscious people have logged onto Weekly Health Update so far this year!) As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.